Provider Demographics
NPI:1528221298
Name:DESHETLER, CATHLEEN AGNES (FNP)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:AGNES
Last Name:DESHETLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 DUTCHESS TPKE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6444
Mailing Address - Country:US
Mailing Address - Phone:845-473-4537
Mailing Address - Fax:845-473-7804
Practice Address - Street 1:696 DUTCHESS TPKE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6444
Practice Address - Country:US
Practice Address - Phone:845-473-4537
Practice Address - Fax:845-473-7804
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ31921Medicare UPIN